Garg Archit, Bassi Mehak, Broder Arkady
Internal Medicine, Saint Peter's University Hospital, New Brunswick, USA.
Gastroenterology and Hepatology, Saint Peter's University Hospital, New Brunswick, USA.
Cureus. 2024 Dec 2;16(12):e74989. doi: 10.7759/cureus.74989. eCollection 2024 Dec.
Acute esophageal necrosis (AEN), also known as black esophagus or Gurvits syndrome, is an uncommon endoscopic finding characterized by diffuse, circumferential, black discoloration of the esophagus that terminates at the gastroesophageal junction. The incidence of AEN has been reported to be 0-0.2% in autopsy series and up to 0.2% in observational studies. More common in elderly men, AEN usually presents with signs of upper gastrointestinal bleeding, such as hematemesis and melena, and is diagnosed by upper endoscopy. In severe cases, it can cause hemorrhagic shock, esophageal perforation, and mediastinitis. We present the case of a 78-year-old male with a history of diabetes mellitus, coronary artery disease, and peripheral arterial disease who presented with abdominal pain, obstipation, and vomiting for four days. He was found to have a small bowel obstruction secondary to incarcerated inguinal hernia and underwent hernia repair. The postoperative course was complicated by gastrointestinal bleeding requiring endoscopic examination, which revealed black discoloration of the esophagus, confirming the diagnosis of AEN. Management included aggressive fluid resuscitation, proton pump inhibitors, and nutritional support. Endoscopic interventions were performed to control bleeding. Physicians need to have a high index of suspicion for AEN in elderly patients with upper gastrointestinal bleeding due to the increased incidence in this age group. Early diagnosis and management can prevent complications and improve outcomes.
急性食管坏死（AEN），也称为黑色食管或古尔维茨综合征，是一种罕见的内镜检查发现，其特征为食管弥漫性、环形的黑色变色，止于胃食管交界处。据尸检系列报道，AEN的发病率为0 - 0.2%，在观察性研究中高达0.2%。AEN在老年男性中更为常见，通常表现为上消化道出血的症状，如呕血和黑便，并通过上消化道内镜检查确诊。在严重情况下，它可导致失血性休克、食管穿孔和纵隔炎。我们报告一例78岁男性病例，有糖尿病、冠状动脉疾病和外周动脉疾病史，因腹痛、便秘和呕吐4天就诊。发现他因腹股沟嵌顿疝继发小肠梗阻，并接受了疝修补术。术后病程因需要内镜检查的胃肠道出血而复杂化，内镜检查发现食管黑色变色，确诊为AEN。治疗包括积极的液体复苏、质子泵抑制剂和营养支持。进行了内镜干预以控制出血。由于该年龄组发病率增加，医生对老年上消化道出血患者的AEN需要有高度的怀疑指数。早期诊断和治疗可预防并发症并改善预后。
